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Family Planning, Human Rights, and the Population Establishment

John S. Aird September 1, 1993

For much of the twentieth century the prevailing view of human population growth in intellectual circles throughout the Western world has been essentially Malthusian. It has held that an excessively rapid growth rate has an adverse impact on human welfare, especially in the so-called “developing” countries which make up most of Africa, Asia, and Latin America. In the 1970s this idea resulted in a major redirection of foreign assistance funds away from economic development projects and into family planning projects. It gave rise to the “rat hole” thesis, which asserted that aid to developing countries was futile unless population growth was first brought under control.

Population panics

In the 1950s and 1960s publicists like Harrison Brown and William Vogt warned that population growth not only caused economic problems but threatened the survival of our species. Most implied that the catastrophe was imminent and getting closer but did not attempt to specify a timetable for it. However, one, Paul Ehrlich, has made a career of dire predictions that were explicit enough to be put to the test of actual experience. In the late 1960s, Ehrlich declared that the battle to feed humanity had already been lost and that hundreds of millions of people would starve to death in a worldwide famine during the 1970s. In 1970 he warned that in the next two decades air pollution could easily lead to “massive starvation” in the United States, complicated by a “water crisis” as early as 1930. Twenty years later, in a book titled The Population Explosion, Ehrlich and his wife Amie insisted that hunger was “rife” in the world and “the prospects of famine and plague ever more imminent.”

The Ehrlichs were not the only people making predictions of this kind. Others asserted that famine was inescapable and that it was time to institute compulsory family planning in various places, including the United States. Garrett Hardin went even farther than the Ehrlichs, insisting in a 1969 article titled, “The Inhumanity of Being Soft-hearted” that sending food to starving people was “the worst thing we can do. Atom bombs would be kinder.” I suspect that had Hardin consulted the intended recipients of this kindness they might have preferred the cruelty of food relief instead!

The population crisis vs. empirical evidence

What is most striking about the predictions of impending disaster and the extreme remedies proposed is the great certainty with which they are put forward. There is, in fact, no empirical basis for this certainty. There have been numerous studies of the consequences of population growth, but taken collectively their results have been equivocal at best. In 1958, on the basis of data from India and Mexico, Ansley Coale and Edgar Hoover reached the conclusion that rapid population growth and the consequent high dependency ratios impeded physical capital formation. A 1971 National Academy of Sciences study concluded that population growth had a generally negative effect on economic development, even though the data it compiled showed no association between the two factors. Studies based on computer models also came up with pessimistic conclusions, and these were widely publicized by the 1980 Global 2000 Report to the President.

However, in the late 1960s, economists Simon Kuznets and Richard Easterlin cautioned that the actual effects of population growth on economic development were complex and not yet well understood and that data from developing countries showed no correlation between population growth and growth in per capita income. Kuznets concluded that there was therefore no basis either for complacency or for alarm. In 1973, economist Julian Simon and sociologist Avery Guest challenged the concept of overpopulation, and Simon cited evidence that moderate population growth is a stimulus to economic development, rapid population growth only a slight deterrent, and zero growth and population decline strong deterrents. Others questioned the validity of computer models as surrogates for complex human realities.

The decade of the 1970s witnessed an unprecedented rise in income per capita, literacy, and life expectancy even in developing countries with high population growth rates, a trend that did not fit with the pessimistic scenario. The trend continued in the next decade. World Bank data showed that, with a few exceptions, nutrition in the wor1d’s poorer countries had undergone a modest improvement. Timothy King and other World Bank economists also cast doubt on the population crisis idea. In 1981 Simon argued that population growth encouraged economic development through its effects on technology, innovation, market formation, and investments.

In 1986 the National Academy of Sciences undertook another study that came to much less pessimistic conclusions than had its 1971 study. The new study rejected earlier findings that population growth has negative impacts on exhaustible resources, pollution, savings and investment, manpower and employment, and urbanization. It sustained the earlier argument that population growth may cause excessive consumption of renewable resources and questioned the value of economies of scale resulting from urbanization. But the study affirmed that in general population growth does not have a serious impact on economic growth. These findings were promptly denounced as “revisionist” by adherents of the crisis view, a curious reproach, since it implies that one ought to remain faithful to old convictions even when they are contradicted by new evidence, an attitude that hardly accords with the canons of social science.

Obviously the last word has not been written on this subject. There will no doubt be further research as statistical evidence accumulates and more intensive examinations into the dynamic connections between population growth and other factors affecting economic development, health, education resource utilization, environmental pollution, and other factors in the human welfare equation. Nevertheless, the failure of current data to show a correlation between population growth rates and other measures of human welfare is itself a highly significant finding. The crisis idea implicitly assumes that population growth has a simple, direct, and inexorably negative impact on welfare, which should mean that even crude and incomplete data from developing countries should show at least a mild to moderate negative correlation between the two categories of factors. The fact that no such correlation has appeared suggest either that population growth has little or no effect on welfare, or that its effects are contradictory and self-neutralizing. This conclusion seems unlikely to be overturned by future research except perhaps in special national or regional circumstances, and it has some important implications for international assistance in general and family planning in particular.

One of the participants in the NAS study, the demographer Samuel Preston, said that because the relationship between population growth and income per capita is “about as random and unstructured as any relation in the social sciences,” there was no basis for the “doomsday scenario” used by family planning advocates to promote their cause. It gets public attention and brings in money, he said, but it is “simple minded and incorrect, casually attributing any human problem to there being too many humans.” He warned that those who use it may crash with it when it is finally shot down.

Conflicts of interest

In fact, the crisis view has been losing ground in professional circles since the 1970s, even while, ironically, it was gaining ground among the general public. But many demographers and family planning advocates still cling to it as though it were a life preserver which, in one sense at least, it is. For it is a fact that the general perception of an impending population crisis has resulted in an influx of research funds into demography and of project money into family planning. For both it has proven to be a goose that still lays golden eggs even after becoming a dead duck, and they are in no hurry to dispose of the carcass!

As advocates of many other humanitarian causes have learned, compassion does not elicit as much public support as does fear of disaster. Since alarm brings in money, those who raise funds by sounding alarms have a vested interest in keeping the public scared. Their supporters, who have invested heavily in what they thought were moral causes, are reluctant to believe their perceptions were flawed and their energies misdirected. These failings are by no means peculiar to demographers and family planners. None of us is inclined to surrender long held convictions without a struggle, especially convictions that have given us employment, public recognition, or the feeling of being both right and righteous. But social scientists, whose findings often affect public policy, have a professional obligation not to reach conclusions that go beyond the warrant of their evidence and to abandon those that are contradicted by new evidence. Other citizens have at least an ethical obligation to change their minds whenever they find that their previous views were in error.

Unfortunately, these obligations are not always fulfilled. When personal or professional advantage and ideological commitments conflict with intellectual integrity, the conflict is all too often resolved at the expense of integrity. This has frequently happened among adherents of the population crisis idea, who have some- times engaged in public deception, withholding of information, attempts to suppress opposing views, and blatant hypocrisy. The hypocrisy is conspicuous when demographers and family planners ignore, deny, or excuse the use of coercive measures in family planning while maintaining that they approve only voluntary measures.

For example, in 1976 the government of India authorized state governments to adopt “legislation for compulsory sterilization” whenever they felt that the time for such action was ripe. Only one state, Maharashtra, actually did so, but instances of compulsory sterilization were widely reported in other areas as well. Local officials use control over permits, licenses, employment, and school admissions — and in some places denial of food rations, salary forfeitures, threats and physical force — to compel people to submit. Between July and December 1976 six million people were sterilized. One analyst said the coercive measures were a local response to government pressure to carry out large numbers of sterilizations immediately with no questions asked and no excuses accepted. Since India was a democracy, the adverse public reaction helped bring down the government and moderate the program, but many foreign agencies either applauded the Indian program, as did Robert McNamara, then head of the World Bank, or refrained from criticism and thus gave tacit approval.

Coercion in the Chinese family planning program

The Chinese family planning program has employed coercion much more extensively and successfully, if success is measured only in demographic terms. In the 1970s the Chinese total fertility rate declined by 62 percent, due in large measure to compulsory insertion of intrauterine devices in women with two or more children. The Chinese program survived several changes of government and is still going on. It reached its all-time peak of coerciveness in 1983, when a national directive from the State Family Planning Commission, with prior approval by the Party Central Committee and the State Council, demanded that women with one child have IUDs inserted, one spouse of couples with two or more children be sterilized, and all unauthorized pregnancies aborted. Semi-trained surgical teams fanned out over the countryside to apprehend those targeted for the various surgeries and perform them on the spot. In that one year, 21 million sterilizations, 18 million IUD insertions, and 14 million abortions were carried out. Public reaction against this drive was so strong that a temporary relaxation was ordered by the central authorities in 1984, but from about April 1985 up to the present time the program has been gradually escalating. It remains the most coercive family planning program the world has ever seen.

Chinese government spokesmen, when addressing foreign audiences, regularly claim that their program is voluntary and that instances of coercion are merely local deviations from national policy by cadres who don’t understand it properly. They say that all such cases are punished as soon as they are detected. However, they have yet to publicize a case of a lower level official punished for using coercive tactics, though they often publicize cases of punishment for local officials who neglect family planning. Besides, none of the provincial family planning regulations that have come to hand thus far contains prohibitions against coercion or specifies penalties for those who use such means. Instead, the authorities have often applauded the results obtained by coercive measures and have sometimes cited such measures as examples of “meticulous ideological work.”

Despite official disclaimers, media reports indicate that coercion is widespread in the Chinese program. Some of the measures described involve direct physical coercion, such as arresting pregnant women and taking them to the abortion clinics in handcuffs, confining them in cattle sheds until they acquiesce, carrying out sterilization or abortion without their knowledge while rendering other medical services, injecting alcohol or formaldehyde into the skulls of crowning infants so that they are born dead or crushing their skulls with the forceps during delivery, forcing pregnant women to attend “study classes” away from their families until they agree to have abortions, imprisoning husbands until their fugitive wives return for the required surgeries, cutting off food, water, and wages for non-compliant families, confiscating their possessions, and expelling them from or dismantling their houses. Most of these measures have not been publicly endorsed by the central authorities, but efforts to discourage them have been at best intermittent and half-hearted. “Mass mobilizations,” a definitely approved method with coercive implications, are frequently demanded by the authorities. The tactics used during “mobilizations” are seldom specified, but the fact that they cause many people to flee their homes suggests that those who get caught are not able to refuse what is demanded of them.

Other coercive tactics are more indirect. They include extreme economic, political, social, and psychological pressures. Economic penalties for unauthorized pregnancies can amount to more than a family’s total annual income and penalties for unauthorized births can amount to 40 percent of the family’s total income and continue for up to 14 years. Political and social pressures include the use of collective punishments for individual deviations, the intent of which is to induce others to ostracize and persecute nonconformists until they fall into line. For example, several provinces refuse permission for an authorized second birth to eligible couples in villages that have a single unauthorized pregnancy. A whole factory work force may be denied bonuses, promotions, and other benefits for a year because one member had an unauthorized child. Psychological pressures include public humiliations and repeated visits by local cadres and officials to the homes of couples with unauthorized pregnancies to have “hear-to-heart” talks with them, which continue until they cannot stand the pressure and submit to abortion. Many of these measures are cited for emulation in the national family planning journal or in provincial progress reports. Clearly they have central approval.

Female infanticide

Another indicator of coercion in the Chinese program is the resurgence of female infanticide in China after the adoption of the one-child limit. Among peasant families, a son is the only assurance of security in old age. Daughters in China usually join the families of their husbands and are in no position to support their own aging parents. As recently as 1989 only 1.7 percent of rural families were assured of subsistence pay after retirement and only 29 percent of urban families were covered. The authorities insist that China will have a national social security system in place by the time today’s peasant couples need it, but the peasants know from past experience that government promises cannot be trusted.

In 1979 peasant couples began destroying first-born daughters in the hope that they could try again for a son. The Chinese media acknowledged the connection between female infanticide and the one-child policy as early as 1981, and in 1982 they warned that a serious imbalance in the sexes would result if the practice were not checked. This warning has recently been issued again; it was revealed in December 1992 that the recorded sex ratio at birth in China has now reached an incredible 114 males per 100 females, well above the normally expected ratio of 105:106, which implies that each year some 800,000 female infants are missing! The Chinese authorities have often condemned female infanticide and have taken legal actions to suppress it, but it would stop immediately without the need for legal restraint if they abandoned mandatory childbearing limits.

Foreign assistance to coercive family planning in China

The Chinese program was a litmus test of the sincerity of international organizations that claimed to support only voluntary family planning. Many failed the test. They openly lauded the Chinese program, approved its goals, condoned its methods, contributed financial and technical assistance, repeated disingenuous Chinese government claims that the program is voluntary, and commended it as a model for other countries.

How could they have let themselves become involved in such an inhumane enterprise in violation of their espoused principles? Could they have blundered into it out of ignorance? Possibly, but that explanation strains credulity. Surely any generally informed person who came to adulthood before the middle of this century must have been aware that China had been ruled since 1949 by leaders who had no hesitation about using violent means to implement unpopular policies and programs. The collectivization drive of the middle 1950s that took back the land given to the peasants during “land reform” three years earlier and reduced them again to the status of landless laborers had already demonstrated both the willingness and the ability of the central authorities to coerce their people. The Great Leap Forward that caused some 25 to 30 million unnecessary deaths in rural China in 1958-61 and the Cultural Revolution that caused thousands of deaths in the middle l960s provided further evidence of how little the Chinese regime care about human life, let alone human rights.

Evidence from the Chinese media had made it clear as early as the 1950s that there was considerable resistance to birth control and resentment at government interference in private affairs. Some promotional tactics described in the Chinese media at that time were clearly meant to be coercive. In the 1960s rural resistance was extensively discussed in the Chinese press, and the contempt of the authorities for peasant family values was conspicuous. Therefore when the national birth rate plunged precipitously in the 1970s there was good reason to suspect that. something other than persuasion was operating.

If, in spite of these obvious facts, the leaders of foreign family planning agencies were still in doubt, they could have consulted foreign specialists on Chinese population policy, but they did not do so. Why not? Did they really want to find out whether or not the Chinese program was coercive, or did they already know they did not want to know more? Whatever the reason, their lack of curiosity was spectacular.

First and foremost among the agencies that rushed to embrace the Chinese program was the United Nations Population Fund (UNFPA), but the International Planned Parenthood federation (IPPF) was not far behind. In 1979, as the Chinese government was initiating its highly coercive one-child policy, the UNFPA was negotiating the first of three five-year programs of assistance to that governments “population activities,” including family planning, and committing $50 million for the purpose.

In 1983, the peak year for coercion in the Chinese program, a United Nations committee on which Raphael Salas, then head of the UNFPA, served as advisor, gave the first two U.N. population awards to Indian Prime Minister Indira Gandhi, whose government had approved compulsory sterilization in the 1970s, and Qian Xinzhong, Minister-in-Charge of the State Family Planning Commission, who directed the 1983 surgery drive. In that same year, the Chinese Family Planning Association, a government-controlled, pseudo-private citizens group set up to assist the government’s family planning efforts, was welcomed to full membership in the IPPF. In subsequent years the IPPF has provided more than $8 million to the Chinese family planning program.

The Chinese authorities interpreted these actions as unqualified approval of their family planning program, and public statements by foreign family planning advocates validated that interpretation. In 1981 Salas said the program was a “superb example” of integrating population goals with national development plans. In 1982 Fred Pinkham, president of the Population Crisis Committee, cited with approval assurances from Qian Xinzhong that the Chinese program was voluntary. In 1983 IPPF officials visiting China at Qian’s invitation said its success was due to the fact that “the masses have an understanding of family planning” and “it is the people’s own choice.” In 1984 Salas denied that the UNFPA had any evidence that its program in China supported coercive measures, and in 1985 he reportedly told then-Premier Zhao Ziyang that “China’s family planning policy is established on the basis of voluntary acceptance by the people” and that China should be proud of its achievements in family planning. Also in 1985 the UNFPA told USAID that the Chinese program advocated one child per couple but did not require compliance.

As the years passed, the evidence of coercion in the Chinese program both from domestic sources and from reports of foreigners in China became overwhelming. The foreign agencies that had committed themselves to the program therefore had a problem. To withdraw their support would have outraged the Chinese authorities and drawn attention to their own ineptitude in getting involved despite the warning signs. If they acknowledged the coerciveness of the program but continued to support it, their position would be openly and inexplicably hypocritical. The option that threatened the least immediate damage was to deny the evidence of coercion and continue their support of the Chinese program. Thus far, they have gotten away with it. Only the United States, the UNFPA’s largest single contributor, withheld funds beginning in 1985 because of the agency’s support of a coercive program. Now there are signs that the U.S. may shortly resume funding of the UNFPA, which will prove to all the world that even governments that make a great show of respecting human rights care little about human rights violations in family planning.

Human Rights and the UNFPA

Most family planning organizations and most population control advocates at least nominally endorse the principle of reproductive freedom as a basic human right. The World Population Plan of Action adopted at the 1974 World Population Conference in Bucharest acknowledged “the basic human right of all couples and individuals to decide freely and responsibly the number and spacing of their children,” and the 1984 conference in Mexico City reaffirmed that right and added that parents should be allowed to fulfill their responsibilities “freely and without coercion.” Neither conference indicated what was meant by “responsible” childbearing nor did they make clear who had the authority to do what in cam of “irresponsible” childbearing. They provided no guidance on what constituted coercion. These matters were left so ambiguous that the Chinese government could baldly claim that its program is in full accord with the principles laid down at both conferences.

In 1985 Raphael Salas asserted that the UNFPA was guided by three principles, the second of which was the principle of reproductive freedom, but his first principle was “respect for national sovereignty” which, he said, means that:

…countries are and must remain free to decide on their own attitudes and responses to questions of population. The United Nations system is not equipped, either by law or by practice, to go behind this principle and judge the moral acceptability of programs .… The relationship of individual freedom to the needs of society as a whole is a matter for each country to decide.

Thus, the principle of national sovereignty as construed by Salas eclipsed the principle of reproductive freedom. Instead of being a universal right, reproductive freedom meant whatever a national government decided it should mean. In China it means, in effect, the right to have children only if and when the government approves.

In 1986, Nafis Sadik said, “any limitations on the exercise of personal and voluntary choice of [family planning] methods represents a violation of the right to have access to family planning,” but then she added that “judgments about what constitutes free and informed choice must be made within the context of a particular culture and the context of the overall government programme for social and economic development .…” The meaning of freedom and even of “informed consent,” instead of being universal principles limiting government encroachments on human rights, has been transformed by the UNFPA into a carte blanche authorization for government control of childbearing. Farewell reproductive freedom!

Human rights and the world population conferences

Is the UNFPA’s position on these matters consistent with what participants in the World Population Conferences of 1974 and 1984 had in mind in adopting their “plans of action”? One cannot be sure. The 1974 conference said that the formulation of national population goals and policies should be “democratic,” but it left them undefined also and did not explain how policies could be formulated democratically in countries ruled by dictatorships. Again, the ambiguity allowed each government to define “democracy” in its own way. The Chinese Communist Party has always maintained that its rule incorporate the principle of “the people’s democratic dictator- ship,” which maintains that since the Party’s actions always express the will of the people, the Party leaders are free to use dictatorial powers against those who resist, even if they constitute the majority of the people. Hence, in their terms, government policies that go against the popular will are nevertheless “democratic.”

Perhaps the World Population Conferences left many important terms undefined because defining them would have offended governments like that of the People’s Republic of China. A facade of unanimity was achieved by leaving ample latitude for divergent interpretations. On the other hand, one suspects that many of the conferees, certainly including population crisis believers, were not equally enthusiastic about all aspects of reproductive freedom. Most probably felt strongly about the right of couples or of women not to have unwanted children but many would not have been inclined to protect the right to have children beyond the small numbers they think appropriate, in which case they would not have been much interested in taking steps to discourage coercive family planning. It remains to be seen whether the 1994 Cairo conference will be any more explicit about these matters.

If the 1994 conferees really want to come to grips with the coercion issue, they will need to come up with a clear and explicit definition that includes both pronatalist and antinatalist coercion. I think the term should be applied to any policy or measure that obliges a significant number of couples or women either to have children they do not want or not to have children they want. It should not be applied to policies the implementation of which occasions a loss of reproductive freedom only in rare, accidental, or unanticipated instances as long as those in charge take prompt action to alleviate these situations and prevent recurrence, but measures need not violate the rights of the majority to be considered coercive. Even if they compel only small numbers of couples or women, especially the poor, minorities, people with particular health conditions, or other vulnerable segments of the population to act against their will, the measures must still be regarded as coercive. Programs and tactics devised at higher levels that tend to incite local managers and field workers to resort to compulsion should be considered coercive, even if the local actions are not approved or are expressly forbidden by the higher levels.

Tactics that are unequivocally coercive include physical coercion, harassment, threats and intimidation, public humiliation, heavy fines or other severe penalties, and incentives that profoundly affect the health and welfare of a woman or her family so that what is offered as an inducement is so necessary that she cannot afford to tum it down. Group penalties the purpose or effect of which is to generate peer pressures that make it difficult or impossible for deviant couples or women to resist program demands are also clearly coercive. Goals and targets are coercive if failure to attain them can adversely affect local welfare or the remuneration and career advancement of program managers, officials, and functionaries, circumstances which often cause local authorities to meet their quotas by coercive means. When the World Bank or USAID give further assistance to a developing country contingent on its attainment of population targets, they are responsible for whatever abuses occur at lower levels in the struggle to meet their requirements. In the last analysis, whether or not a particular policy or program is coercive depends not on the intentions, philosophies or principles claimed by the implementing governments, agencies or institutions but on their effects at the grass roots level. Official denials are not proof of innocence.

Human rights, ethics, and coercive family planning

Because definitive scientific knowledge about the consequences of population growth is lacking, there can be no ethical basis at present either for pronatalist or antinatalist encroachments on reproductive freedom. The case for compulsory measures in any specific situation would have to rest on a reasonably firm determination that the injury to human welfare caused by population growth under a voluntary approach was greater than that caused by coercion. To make that case, it would be necessary to establish that population growth was a major, direct cause of human misery, that coercive family planning would bring a significant measure of relief, and that there was no effective alternative remedy — economic, political, or social — that did not entail even greater human costs. Finally, it would be necessary to ascertain how much coercion was needed to secure the essential relief and to make sure that no more was applied than the situation required.

The evidence on which these determinations were based would have to be systematic, substantial, and beyond reasonable doubt, and its collection, evaluation, and interpretation could not be entrusted to anyone, regardless of renown or expertise, who stood to gain personally or professionally from the outcome. Only the dispassionate analysis of objective evidence by a number of disinterested social scientists and scholars could provide a basis for so important a decision. Arguments that use simplistic analogies, number stock, unsubstantiated categorical assertions, and overblown rhetoric are useless for this purpose. Until a specific case arises in which the need for coercion can be established using proper analytical procedures with the proper safeguards, coercive measures must be regarded as unjustifiable and unethical, in China and everywhere else. The failure of the population establishment to condemn coercive family planning as a violation of human rights compromises its credibility and its claim to serve a humanitarian cause.

John S. Aird is an internationally known and respected demographer. He is also the former head of the China section of the U.S. Census Bureau.

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